Copper Queen Community Hospital

All Charges

Charge

Type

Setting

Price

Aldolase LC

Facility

$280.00

Service Code	CPT 82085
Hospital Charge Code	1285776
Hospital Revenue Code	301
Min. Negotiated Rate	$44.80
Max. Negotiated Rate	$252.00
Rate for Payer: Aetna of AZ Commercial	$252.00
Rate for Payer: Aetna of AZ Medicare	$78.40
Rate for Payer: Allwell Medicare	$44.80
Rate for Payer: Amerigroup Medicare	$44.80
Rate for Payer: APIPA Medicare/Medicaid	$104.58
Rate for Payer: AZCH Complete Medicare	$44.80
Rate for Payer: Banner UC Health Medicare	$44.80
Rate for Payer: Bisbee Police All Plans	$72.80
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$190.40
Rate for Payer: Cash Price	$224.00
Rate for Payer: Cigna of AZ Commercial	$182.00
Rate for Payer: Copperpoint Commercial	$69.30
Rate for Payer: Health Net of AZ Commercial	$168.00
Rate for Payer: Health Net of AZ Medicare	$78.40
Rate for Payer: Humana of AZ Medicare	$44.80
Rate for Payer: Self Pay Self Pay	$224.00
Rate for Payer: TriWest Medicare	$44.80
Rate for Payer: UnitedHealth Group of AZ Commercial	$163.24
Rate for Payer: UnitedHealth Group of AZ Medicare	$50.40

Aldolase LC

Facility

$280.00

Service Code	CPT 82085
Hospital Charge Code	1285776
Hospital Revenue Code	301
Min. Negotiated Rate	$72.80
Max. Negotiated Rate	$252.00
Rate for Payer: Aetna of AZ Commercial	$252.00
Rate for Payer: Bisbee Police All Plans	$72.80
Rate for Payer: Cash Price	$224.00
Rate for Payer: Self Pay Self Pay	$224.00

Aldosterone LCMS, Serum LC

Facility

$483.00

Service Code	CPT 82088
Hospital Charge Code	2029095
Hospital Revenue Code	301
Min. Negotiated Rate	$77.28
Max. Negotiated Rate	$434.70
Rate for Payer: Aetna of AZ Commercial	$434.70
Rate for Payer: Aetna of AZ Medicare	$135.24
Rate for Payer: Allwell Medicare	$77.28
Rate for Payer: Amerigroup Medicare	$77.28
Rate for Payer: APIPA Medicare/Medicaid	$180.40
Rate for Payer: AZCH Complete Medicare	$77.28
Rate for Payer: Banner UC Health Medicare	$77.28
Rate for Payer: Bisbee Police All Plans	$125.58
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$328.44
Rate for Payer: Cash Price	$386.40
Rate for Payer: Cigna of AZ Commercial	$313.95
Rate for Payer: Copperpoint Commercial	$119.54
Rate for Payer: Health Net of AZ Commercial	$289.80
Rate for Payer: Health Net of AZ Medicare	$135.24
Rate for Payer: Humana of AZ Medicare	$77.28
Rate for Payer: Self Pay Self Pay	$386.40
Rate for Payer: TriWest Medicare	$77.28
Rate for Payer: UnitedHealth Group of AZ Commercial	$281.59
Rate for Payer: UnitedHealth Group of AZ Medicare	$86.94

Aldosterone LCMS, Serum LC

Facility

$483.00

Service Code	CPT 82088
Hospital Charge Code	2029095
Hospital Revenue Code	301
Min. Negotiated Rate	$125.58
Max. Negotiated Rate	$434.70
Rate for Payer: Aetna of AZ Commercial	$434.70
Rate for Payer: Bisbee Police All Plans	$125.58
Rate for Payer: Cash Price	$386.40
Rate for Payer: Self Pay Self Pay	$386.40

Aldosterone/Renin Ratio LC

Facility

$483.00

Service Code	CPT 82088
Hospital Charge Code	22311172
Hospital Revenue Code	301
Min. Negotiated Rate	$125.58
Max. Negotiated Rate	$434.70
Rate for Payer: Aetna of AZ Commercial	$434.70
Rate for Payer: Bisbee Police All Plans	$125.58
Rate for Payer: Cash Price	$386.40
Rate for Payer: Self Pay Self Pay	$386.40

Aldosterone/Renin Ratio LC

Facility

$483.00

Service Code	CPT 82088
Hospital Charge Code	22311172
Hospital Revenue Code	301
Min. Negotiated Rate	$77.28
Max. Negotiated Rate	$434.70
Rate for Payer: Aetna of AZ Commercial	$434.70
Rate for Payer: Aetna of AZ Medicare	$135.24
Rate for Payer: Allwell Medicare	$77.28
Rate for Payer: Amerigroup Medicare	$77.28
Rate for Payer: APIPA Medicare/Medicaid	$180.40
Rate for Payer: AZCH Complete Medicare	$77.28
Rate for Payer: Banner UC Health Medicare	$77.28
Rate for Payer: Bisbee Police All Plans	$125.58
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$328.44
Rate for Payer: Cash Price	$386.40
Rate for Payer: Cigna of AZ Commercial	$313.95
Rate for Payer: Copperpoint Commercial	$119.54
Rate for Payer: Health Net of AZ Commercial	$289.80
Rate for Payer: Health Net of AZ Medicare	$135.24
Rate for Payer: Humana of AZ Medicare	$77.28
Rate for Payer: Self Pay Self Pay	$386.40
Rate for Payer: TriWest Medicare	$77.28
Rate for Payer: UnitedHealth Group of AZ Commercial	$281.59
Rate for Payer: UnitedHealth Group of AZ Medicare	$86.94

alfuzosin 10 mg ER Tab [CQCH]

Facility

$0.14

Service Code	NDC 57237011490
Hospital Charge Code	105909840
Hospital Revenue Code	251
Min. Negotiated Rate	$0.04
Max. Negotiated Rate	$0.13
Rate for Payer: Aetna of AZ Commercial	$0.13
Rate for Payer: Bisbee Police All Plans	$0.04
Rate for Payer: Cash Price	$0.11
Rate for Payer: Self Pay Self Pay	$0.11

alfuzosin 10 mg ER Tab [CQCH]

Facility

$0.14

Service Code	NDC 57237011490
Hospital Charge Code	105909840
Hospital Revenue Code	251
Min. Negotiated Rate	$0.02
Max. Negotiated Rate	$0.13
Rate for Payer: Aetna of AZ Commercial	$0.13
Rate for Payer: Aetna of AZ Medicare	$0.04
Rate for Payer: Allwell Medicare	$0.02
Rate for Payer: Amerigroup Medicare	$0.02
Rate for Payer: APIPA Medicare/Medicaid	$0.05
Rate for Payer: AZCH Complete Medicare	$0.02
Rate for Payer: Banner UC Health Medicare	$0.02
Rate for Payer: Bisbee Police All Plans	$0.04
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$0.10
Rate for Payer: Cash Price	$0.11
Rate for Payer: Cigna of AZ Commercial	$0.09
Rate for Payer: Copperpoint Commercial	$0.03
Rate for Payer: Health Net of AZ Commercial	$0.08
Rate for Payer: Health Net of AZ Medicare	$0.04
Rate for Payer: Humana of AZ Medicare	$0.02
Rate for Payer: Self Pay Self Pay	$0.11
Rate for Payer: TriWest Medicare	$0.02
Rate for Payer: UnitedHealth Group of AZ Commercial	$0.08
Rate for Payer: UnitedHealth Group of AZ Medicare	$0.03

Alkaline Phosphatase

Facility

$106.00

Service Code	CPT 84075
Hospital Charge Code	633642
Hospital Revenue Code	301
Min. Negotiated Rate	$16.96
Max. Negotiated Rate	$95.40
Rate for Payer: Aetna of AZ Commercial	$95.40
Rate for Payer: Aetna of AZ Medicare	$29.68
Rate for Payer: Allwell Medicare	$16.96
Rate for Payer: Amerigroup Medicare	$16.96
Rate for Payer: APIPA Medicare/Medicaid	$39.59
Rate for Payer: AZCH Complete Medicare	$16.96
Rate for Payer: Banner UC Health Medicare	$16.96
Rate for Payer: Bisbee Police All Plans	$27.56
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$72.08
Rate for Payer: Cash Price	$84.80
Rate for Payer: Cigna of AZ Commercial	$68.90
Rate for Payer: Copperpoint Commercial	$26.23
Rate for Payer: Health Net of AZ Commercial	$63.60
Rate for Payer: Health Net of AZ Medicare	$29.68
Rate for Payer: Humana of AZ Medicare	$16.96
Rate for Payer: Self Pay Self Pay	$84.80
Rate for Payer: TriWest Medicare	$16.96
Rate for Payer: UnitedHealth Group of AZ Commercial	$61.80
Rate for Payer: UnitedHealth Group of AZ Medicare	$19.08

Alkaline Phosphatase

Facility

$106.00

Service Code	CPT 84075
Hospital Charge Code	633642
Hospital Revenue Code	301
Min. Negotiated Rate	$27.56
Max. Negotiated Rate	$95.40
Rate for Payer: Aetna of AZ Commercial	$95.40
Rate for Payer: Bisbee Police All Plans	$27.56
Rate for Payer: Cash Price	$84.80
Rate for Payer: Self Pay Self Pay	$84.80

Alk Phos Isoenzyme LC

Facility

$151.00

Service Code	CPT 84080
Hospital Charge Code	1905896
Hospital Revenue Code	301
Min. Negotiated Rate	$24.16
Max. Negotiated Rate	$135.90
Rate for Payer: Aetna of AZ Commercial	$135.90
Rate for Payer: Aetna of AZ Medicare	$42.28
Rate for Payer: Allwell Medicare	$24.16
Rate for Payer: Amerigroup Medicare	$24.16
Rate for Payer: APIPA Medicare/Medicaid	$56.40
Rate for Payer: AZCH Complete Medicare	$24.16
Rate for Payer: Banner UC Health Medicare	$24.16
Rate for Payer: Bisbee Police All Plans	$39.26
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$102.68
Rate for Payer: Cash Price	$120.80
Rate for Payer: Cigna of AZ Commercial	$98.15
Rate for Payer: Copperpoint Commercial	$37.37
Rate for Payer: Health Net of AZ Commercial	$90.60
Rate for Payer: Health Net of AZ Medicare	$42.28
Rate for Payer: Humana of AZ Medicare	$24.16
Rate for Payer: Self Pay Self Pay	$120.80
Rate for Payer: TriWest Medicare	$24.16
Rate for Payer: UnitedHealth Group of AZ Commercial	$88.03
Rate for Payer: UnitedHealth Group of AZ Medicare	$27.18

Alk Phos Isoenzyme LC

Facility

$151.00

Service Code	CPT 84080
Hospital Charge Code	1905896
Hospital Revenue Code	301
Min. Negotiated Rate	$39.26
Max. Negotiated Rate	$135.90
Rate for Payer: Aetna of AZ Commercial	$135.90
Rate for Payer: Bisbee Police All Plans	$39.26
Rate for Payer: Cash Price	$120.80
Rate for Payer: Self Pay Self Pay	$120.80

ALLERGEN CHOC

Facility

$62.00

Service Code	CPT 86003
Hospital Charge Code	22481451
Hospital Revenue Code	302
Min. Negotiated Rate	$9.92
Max. Negotiated Rate	$55.80
Rate for Payer: Aetna of AZ Commercial	$55.80
Rate for Payer: Aetna of AZ Medicare	$17.36
Rate for Payer: Allwell Medicare	$9.92
Rate for Payer: Amerigroup Medicare	$9.92
Rate for Payer: APIPA Medicare/Medicaid	$23.16
Rate for Payer: AZCH Complete Medicare	$9.92
Rate for Payer: Banner UC Health Medicare	$9.92
Rate for Payer: Bisbee Police All Plans	$16.12
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$42.16
Rate for Payer: Cash Price	$49.60
Rate for Payer: Cigna of AZ Commercial	$40.30
Rate for Payer: Copperpoint Commercial	$15.35
Rate for Payer: Health Net of AZ Commercial	$37.20
Rate for Payer: Health Net of AZ Medicare	$17.36
Rate for Payer: Humana of AZ Medicare	$9.92
Rate for Payer: Self Pay Self Pay	$49.60
Rate for Payer: TriWest Medicare	$9.92
Rate for Payer: UnitedHealth Group of AZ Commercial	$36.15
Rate for Payer: UnitedHealth Group of AZ Medicare	$11.16

ALLERGEN CHOC

Facility

$62.00

Service Code	CPT 86003
Hospital Charge Code	22481451
Hospital Revenue Code	302
Min. Negotiated Rate	$16.12
Max. Negotiated Rate	$55.80
Rate for Payer: Aetna of AZ Commercial	$55.80
Rate for Payer: Bisbee Police All Plans	$16.12
Rate for Payer: Cash Price	$49.60
Rate for Payer: Self Pay Self Pay	$49.60

ALLERGEN CORN

Facility

$62.00

Service Code	CPT 86003
Hospital Charge Code	22481452
Hospital Revenue Code	302
Min. Negotiated Rate	$16.12
Max. Negotiated Rate	$55.80
Rate for Payer: Aetna of AZ Commercial	$55.80
Rate for Payer: Bisbee Police All Plans	$16.12
Rate for Payer: Cash Price	$49.60
Rate for Payer: Self Pay Self Pay	$49.60

ALLERGEN CORN

Facility

$62.00

Service Code	CPT 86003
Hospital Charge Code	22481452
Hospital Revenue Code	302
Min. Negotiated Rate	$9.92
Max. Negotiated Rate	$55.80
Rate for Payer: Aetna of AZ Commercial	$55.80
Rate for Payer: Aetna of AZ Medicare	$17.36
Rate for Payer: Allwell Medicare	$9.92
Rate for Payer: Amerigroup Medicare	$9.92
Rate for Payer: APIPA Medicare/Medicaid	$23.16
Rate for Payer: AZCH Complete Medicare	$9.92
Rate for Payer: Banner UC Health Medicare	$9.92
Rate for Payer: Bisbee Police All Plans	$16.12
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$42.16
Rate for Payer: Cash Price	$49.60
Rate for Payer: Cigna of AZ Commercial	$40.30
Rate for Payer: Copperpoint Commercial	$15.35
Rate for Payer: Health Net of AZ Commercial	$37.20
Rate for Payer: Health Net of AZ Medicare	$17.36
Rate for Payer: Humana of AZ Medicare	$9.92
Rate for Payer: Self Pay Self Pay	$49.60
Rate for Payer: TriWest Medicare	$9.92
Rate for Payer: UnitedHealth Group of AZ Commercial	$36.15
Rate for Payer: UnitedHealth Group of AZ Medicare	$11.16

ALLERGEN EGG

Facility

$62.00

Service Code	CPT 86003
Hospital Charge Code	22481453
Hospital Revenue Code	302
Min. Negotiated Rate	$9.92
Max. Negotiated Rate	$55.80
Rate for Payer: Aetna of AZ Commercial	$55.80
Rate for Payer: Aetna of AZ Medicare	$17.36
Rate for Payer: Allwell Medicare	$9.92
Rate for Payer: Amerigroup Medicare	$9.92
Rate for Payer: APIPA Medicare/Medicaid	$23.16
Rate for Payer: AZCH Complete Medicare	$9.92
Rate for Payer: Banner UC Health Medicare	$9.92
Rate for Payer: Bisbee Police All Plans	$16.12
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$42.16
Rate for Payer: Cash Price	$49.60
Rate for Payer: Cigna of AZ Commercial	$40.30
Rate for Payer: Copperpoint Commercial	$15.35
Rate for Payer: Health Net of AZ Commercial	$37.20
Rate for Payer: Health Net of AZ Medicare	$17.36
Rate for Payer: Humana of AZ Medicare	$9.92
Rate for Payer: Self Pay Self Pay	$49.60
Rate for Payer: TriWest Medicare	$9.92
Rate for Payer: UnitedHealth Group of AZ Commercial	$36.15
Rate for Payer: UnitedHealth Group of AZ Medicare	$11.16

ALLERGEN EGG

Facility

$62.00

Service Code	CPT 86003
Hospital Charge Code	22481453
Hospital Revenue Code	302
Min. Negotiated Rate	$16.12
Max. Negotiated Rate	$55.80
Rate for Payer: Aetna of AZ Commercial	$55.80
Rate for Payer: Bisbee Police All Plans	$16.12
Rate for Payer: Cash Price	$49.60
Rate for Payer: Self Pay Self Pay	$49.60

ALLERGEN FISH/SHELL MIX

Facility

$62.00

Service Code	CPT 86003
Hospital Charge Code	22481454
Hospital Revenue Code	302
Min. Negotiated Rate	$16.12
Max. Negotiated Rate	$55.80
Rate for Payer: Aetna of AZ Commercial	$55.80
Rate for Payer: Bisbee Police All Plans	$16.12
Rate for Payer: Cash Price	$49.60
Rate for Payer: Self Pay Self Pay	$49.60

ALLERGEN FISH/SHELL MIX

Facility

$62.00

Service Code	CPT 86003
Hospital Charge Code	22481454
Hospital Revenue Code	302
Min. Negotiated Rate	$9.92
Max. Negotiated Rate	$55.80
Rate for Payer: Aetna of AZ Commercial	$55.80
Rate for Payer: Aetna of AZ Medicare	$17.36
Rate for Payer: Allwell Medicare	$9.92
Rate for Payer: Amerigroup Medicare	$9.92
Rate for Payer: APIPA Medicare/Medicaid	$23.16
Rate for Payer: AZCH Complete Medicare	$9.92
Rate for Payer: Banner UC Health Medicare	$9.92
Rate for Payer: Bisbee Police All Plans	$16.12
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$42.16
Rate for Payer: Cash Price	$49.60
Rate for Payer: Cigna of AZ Commercial	$40.30
Rate for Payer: Copperpoint Commercial	$15.35
Rate for Payer: Health Net of AZ Commercial	$37.20
Rate for Payer: Health Net of AZ Medicare	$17.36
Rate for Payer: Humana of AZ Medicare	$9.92
Rate for Payer: Self Pay Self Pay	$49.60
Rate for Payer: TriWest Medicare	$9.92
Rate for Payer: UnitedHealth Group of AZ Commercial	$36.15
Rate for Payer: UnitedHealth Group of AZ Medicare	$11.16

ALLERGEN MILK

Facility

$65.00

Service Code	CPT 86003
Hospital Charge Code	22481455
Hospital Revenue Code	302
Min. Negotiated Rate	$16.90
Max. Negotiated Rate	$58.50
Rate for Payer: Aetna of AZ Commercial	$58.50
Rate for Payer: Bisbee Police All Plans	$16.90
Rate for Payer: Cash Price	$52.00
Rate for Payer: Self Pay Self Pay	$52.00

ALLERGEN MILK

Facility

$65.00

Service Code	CPT 86003
Hospital Charge Code	22481455
Hospital Revenue Code	302
Min. Negotiated Rate	$10.40
Max. Negotiated Rate	$58.50
Rate for Payer: Aetna of AZ Commercial	$58.50
Rate for Payer: Aetna of AZ Medicare	$18.20
Rate for Payer: Allwell Medicare	$10.40
Rate for Payer: Amerigroup Medicare	$10.40
Rate for Payer: APIPA Medicare/Medicaid	$24.28
Rate for Payer: AZCH Complete Medicare	$10.40
Rate for Payer: Banner UC Health Medicare	$10.40
Rate for Payer: Bisbee Police All Plans	$16.90
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$44.20
Rate for Payer: Cash Price	$52.00
Rate for Payer: Cigna of AZ Commercial	$42.25
Rate for Payer: Copperpoint Commercial	$16.09
Rate for Payer: Health Net of AZ Commercial	$39.00
Rate for Payer: Health Net of AZ Medicare	$18.20
Rate for Payer: Humana of AZ Medicare	$10.40
Rate for Payer: Self Pay Self Pay	$52.00
Rate for Payer: TriWest Medicare	$10.40
Rate for Payer: UnitedHealth Group of AZ Commercial	$37.90
Rate for Payer: UnitedHealth Group of AZ Medicare	$11.70

ALLERGEN PORK

Facility

$62.00

Service Code	CPT 86003
Hospital Charge Code	22481456
Hospital Revenue Code	302
Min. Negotiated Rate	$16.12
Max. Negotiated Rate	$55.80
Rate for Payer: Aetna of AZ Commercial	$55.80
Rate for Payer: Bisbee Police All Plans	$16.12
Rate for Payer: Cash Price	$49.60
Rate for Payer: Self Pay Self Pay	$49.60

ALLERGEN PORK

Facility

$62.00

Service Code	CPT 86003
Hospital Charge Code	22481456
Hospital Revenue Code	302
Min. Negotiated Rate	$9.92
Max. Negotiated Rate	$55.80
Rate for Payer: Aetna of AZ Commercial	$55.80
Rate for Payer: Aetna of AZ Medicare	$17.36
Rate for Payer: Allwell Medicare	$9.92
Rate for Payer: Amerigroup Medicare	$9.92
Rate for Payer: APIPA Medicare/Medicaid	$23.16
Rate for Payer: AZCH Complete Medicare	$9.92
Rate for Payer: Banner UC Health Medicare	$9.92
Rate for Payer: Bisbee Police All Plans	$16.12
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$42.16
Rate for Payer: Cash Price	$49.60
Rate for Payer: Cigna of AZ Commercial	$40.30
Rate for Payer: Copperpoint Commercial	$15.35
Rate for Payer: Health Net of AZ Commercial	$37.20
Rate for Payer: Health Net of AZ Medicare	$17.36
Rate for Payer: Humana of AZ Medicare	$9.92
Rate for Payer: Self Pay Self Pay	$49.60
Rate for Payer: TriWest Medicare	$9.92
Rate for Payer: UnitedHealth Group of AZ Commercial	$36.15
Rate for Payer: UnitedHealth Group of AZ Medicare	$11.16

Allergen Profile, Basic Food LC

Facility

$62.00

Service Code	CPT 86003
Hospital Charge Code	1902246
Hospital Revenue Code	302
Min. Negotiated Rate	$16.12
Max. Negotiated Rate	$55.80
Rate for Payer: Aetna of AZ Commercial	$55.80
Rate for Payer: Bisbee Police All Plans	$16.12
Rate for Payer: Cash Price	$49.60
Rate for Payer: Self Pay Self Pay	$49.60

Know your out-of-pocket cost for care.

All Charges